What's Good for Diabetes May Be Good for the Heart

Diabetes patients who control their blood sugar levels may lower their heart attack, stroke, heart failure and amputation risks

(RxWiki News) For those with type 2 diabetes, keeping blood sugar levels under control can seem like walking a tightrope. But that delicate balancing act may benefit more than just blood sugar.

A new study from the University of Michigan Health System (UMHS) and the VA Center for Clinical Management Research found that veterans with type 2 diabetes who kept their blood sugar levels under control also lowered their risk for heart attack, stroke, heart failure and amputation.

"Taken together with findings from other large studies, we see that controlling blood sugar in [type 2 diabetes] can indeed decrease cardiovascular risk ..." said lead study author Rodney Hayward, MD, of the VA Ann Arbor Healthcare System and UMHS, in a press release. "This finding reinforces the importance of combining good blood sugar control with control of other cardiovascular risk factors for a combined effect."

In type 2 diabetes, the body's cells do not properly use insulin — the hormone that regulates blood sugar (blood glucose). In type 1 diabetes, the body produces little or no insulin at all.

Dr. Hayward and team looked at more than 1,700 veterans who had type 2 diabetes over a 10-year period.

These patients were randomly divided into two groups. One group received therapy to keep blood sugar under strict control for a six-year period. The other group received only routine medical care.

Patients in the therapy group were given four medications: metformin, a statin, a blood pressure medication and aspirin. Metformin (brand name Glucophage) is a drug that helps control blood sugar. Statins (brand names Crestor, Lipitor, Pravachol and Zocor) are used to lower cholesterol. Aspirin helps to keep the blood from clotting, which may lower the risk of heart attack and stroke.

Blood sugar levels are measured with a lab test called hemoglobin A1c (HbA1c). Patients who don't have diabetes usually have an HbA1c of less than 5.7 percent. An HbA1c of 6.5 percent or above indicates diabetes.

Dr. Hayward and team found that patients who kept their average HbA1c even at about 8 percent had a 17 percent lower risk of heart attack, stroke, heart failure and amputation.

Blood sugar control may be within most patients' reach, according to Dr. Barry Sears, an expert in inflammatory nutrition and creator of the Zone diet.

"It is not very difficult even for a diabetic patient to achieve an HbA1c level of [8 percent] if they are following a good diet and exercise program," Dr. Sears told dailyRx News.

Although having an HbA1c level under 8 percent may be a good goal, Dr. Hayward said care must be individualized to the patient. For instance, some patients may have more episodes of hypoglycemia (low blood sugar) if their blood sugar control is too tight.

"Once someone has his or her [HbA1c level] around 8 percent, we need to individualize treatment to the patient, balancing his or her individual cardiovascular risk based on personal and family history, his or her age and life expectancy, smoking history and medication side effects," Dr. Hayward said. "If you want to determine what the best A1C number is for you, and when you should take another medication to lower it, you should decide with your doctor."

However, Dr. Hayward and team also found that more intensive therapy only delayed the risk of heart problems rather than eliminating them entirely. It also did not appear to affect the overall death rate.

This study was published in the June issue of the New England Journal of Medicine.

The VA Cooperative Studies Program, the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health funded this research.

Study author Dr. Peter D. Reaven disclosed funding from AstraZeneca and Novo Nordisk, and his consulting for Amgen. Study author Dr. Nicholas V. Emanuele received lecture fees from Merck. These companies make diabetes or heart disease medications.

Review Date: 
June 2, 2015